HomeMy WebLinkAboutMortgage_Slipy"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_� .; FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fwm 43709 (R77 / 6-09)
,' ,�,< < PresaibeG M Department of Lo�al Govemment F�ance
File Mark
INSTRUCTIONS: D �-
To be filed in person or by mail with the Counry Auditor or Counry Recorder of the county where the pioperty is located. �
FiNng Dates: 1) Real Pmperty Must file durirg Ne year for which the deducUon is sought � Counry Avditor
2) Mobile / Manufactured Homes not assessed as Real Prziperty Must f+le dunng the fweNe (72) months
before March 31 of each year the deduction is soughG 6 tY Recorder
See reverse side la addttional instruuions and qual�cations. SON COUNTY AU
iesnicD�tns m reverse ffie) �
_ _ „�
w�d �.awe of rea� a�rem as d nwrtyaqe i co�aaa trweece
Mart� t, armn year Mard� 1, wrtent yeer
��If m. what is his I her e� share of inirmt?
H name on tKOrd'6 CtRereni lh2n tha� O( aOP��. udKa[¢ below.
Name ot mort�agea or contraG seller �/ �
Add� W mortgagee w mntrad se0er (numbe� and snee cdy, sbte, aM i
Name of assk,y�ee w othu owner or hdder ot mortgage
Pdtl255 of assignce (num0er aM street, tl y, s!ele, entl ZIP cotle)
Ooes aP�rant avn property in any oNer If yes. what munt�?
counry m Intlana?
❑ Yes ❑ No
Deduction
20 I 20 I 20
/ RemN num0er Page numbej
- 00/. � lS - O� 7 d-DO
aid as o! Mongage / ConvaU indebied�ress unpaid as d Is the epd�i the sole
Oate of appfimtion legal or epuitaWe ovme(t
n Yes ❑ No
spouse, iMkate wlih wt�om
Is iM propnity in puesiion: MnuaOyAssc�sed
[�f Real Property ❑ ArmualyA55essed
r� Mobile Fbme fIC 61.
9
— .�I'811'C!' I�r�..00,O O
.....9. -....
WtatL noperty
C�t'(� 1���. .. � � � ❑
- .........9... -
20 � 20 _ � ZO _ � 20
�reture W� � I Gounry I Da�e (rmnlh, tlaY. Y�h
I I We certify u r ihe penalty of pe ry Nat Ne above and (oregoing infwmalion is We and cortect ard Nat ihe applirant is a resident of Indana arW
owner / wntraq buyer of ihe afae entioned property on date application is filed.
17aMre (�Y�+e/s iW ^ame) .. /� _ Date (rtrornh. daY. Y��)
Fulfresiden{�� p/ appfxant (nR�fer anC sbee4 �: �ta, antl �IP ca
1005 S. �O W, P 2-1� V1 C��
Person authoraetl Ey duty esecuted Power of AttomeY or Oy IC 61.7-72-0.7
Address of authoraed person (number aM streef. dry, srdte, and LP cotle)
oace (nwnm, ear. r�d